Reactive Workflow System and Method

ABSTRACT

A system and method for determining the consequent step of a multi step procedure determines the identity of components usable in the procedure. Based on the components introduced and the context of the procedure at the time the component is introduced determines a consequent step and moves to that determined consequent step.

TECHNICAL FIELD

This invention relates to expert systems and methods and particularlyexpert systems that are usable in a surgical environment.

BACKGROUND ART

The increased use of technology in the surgical suite has led toincreased complexity for the surgeons and their staff. Surgicalnavigation systems allow a surgeon to locate their instruments and toolsaccurately relative to the patient and enable them to perform procedureswith less risk of improper result. However, a surgical navigation systemwith a specialized workflow for a particular procedure requires thesurgeon to interact with the computer system in some fashion. There havebeen improved wireless tools that include the ability to manipulate thecomputer system from a location remote from the computer keyboard ordisplay unit. However, the surgeon must still affirmatively advance thescreen through each step during the procedure.

SUMMARY OF THE INVENTION

One aspect of the present invention is a method for determining aconsequent step within a multi-step procedure. The method comprises thesteps of identifying a context within the procedure; then identifying acomponent usable in the procedure. The method then includes determiningthe consequent step within the procedure based on the identity of thecomponent and the context.

Another aspect of the present invention is a system for assisting with asurgical procedure that comprises a first circuit to identify a contextwithin a multi-step surgical procedure. The system includes a secondcircuit to identify a component that is usable within the procedure.Lastly, the system has a third circuit that determines a consequent stepin the procedure based on the identity of the component and the context.

A still further embodiment of the present invention is a method todetermine a consequent step within a multi-step surgical procedure thatincludes the step of determining a context within the multi-stepsurgical procedure. The method also includes the step of determining theidentity of a surgical instrument and the step of determining thelocation of the surgical instrument. The method then includes the stepof determining the consequent step in the procedure from the context,the identity of the instrument and the identity of the surgicalinstrument.

Other aspects and advantages of the present invention will becomeapparent upon consideration of the following detailed description.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a flow diagram of one embodiment of the method and system ofthe present invention;

FIG. 2 is a flow diagram of one embodiment of a determination of theidentity of a tool with an attachment;

FIG. 3 is a flow diagram of detail of one way to determine the identityof the consequent step;

FIG. 4 is a schematic overview of a surgical navigation system that canbe with an embodiment of the method and system of the present invention;

FIG. 5 is a flow diagram of a further embodiment of the method andsystem of the present invention;

FIG. 6 is flow diagram of an alternate embodiment of the method andsystem of the present invention;

FIG. 7 is a flow diagram of a still further embodiment of the method andsystem of the present invention;

FIG. 8 is a flow diagram of an additional further embodiment of themethod and system of the present invention; and

FIG. 9 is a flow diagram of another embodiment of the method and systemof the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring to FIG. 1, the method and system begin with a block 100 thatdetermines or identifies the current status of the procedure. For asurgical procedure as more fully discussed below or any other computerdirected multi-step procedure, the block 100 will determine where in theseries of display screens the process and the system is presently. Withcurrent computer controlled and directed surgical procedures, thedetermination can be a determination of the current state of thecomputer program. As an example, in a total hip replacement, the currentstep might be the placing of a trial implant in the prepared acetabularcup. The block 100 will know what surgical instruments or tools areneeded for the current step. The system will in a block 102 identify thesurgical instruments brought within the view of the surgical navigationsystem as discussed later. For instance, the surgeon may decide based onthe trial implant that additional reaming is necessary. In this case thesurgeon will introduce the cup reaming instrument into the surgicalfield. The block 102 will identify the reamer and also will identify thesize of the particular reaming tool attached to the reamer. Based on theassessment of the particular tool, a block 104 will determine that thesurgeon wants to return to the reaming display screen to assist thesurgeon with the proper reaming of the acetabular cup. Once the block104 has determined what particular step is to be performed next, a block106 will jump directly to that point within the procedure and a block108 will display the display screen for reaming of the acetabular cupwill then be displayed and the display screen will include the correctparameters for the particular tool or tool attachment. As noted above,the automatic jumping to the correct point within a procedure willgreatly assist the surgeon with their workflow and allow the surgeon toconcentrate upon the surgery at hand and minimize the surgeon'sinteraction with the computer system. It is understood that the stepsnoted above will be repeated for each step through the procedure,including some step more than once, until the conclusion of theprocedure at which time the system and method will terminate.

In FIG. 2, a flow diagram that illustrates how a multipart tool can selfidentify itself and its component parts to the system. A particularmethod and system of this interaction uses RFID and is described in U.S.published application 2003/0093103, the disclosure of which is herebyincorporated by reference. A block 120 identifies the particular baseportion of the surgical tool or instrument. This may be done in a numberof conventional ways including attaching a navigation tracking device tothe instrument and registering the instrument and tracker combinationwith the system or using RFID to identify the tool to the system.Because in most such systems, each tracking device can uniquely identifyitself to the system, the system will know that a particular tool hasbeen attached or associated with that particular tracking device. Forinstance, the reaming tool described above can be either attached to aparticular navigation-tracking device or include built in trackingelements. When that tracking device is later located by the navigationsystem, the block 120 will know that the particular reaming tool hasbeen chosen by the surgeon and has been introduced into the surgicalfield. A block 122 using the RFID, or other similar techniques, willidentify the particular reaming cup that has been attached to thereaming tool, including the size, shape, and any other important oridentifying parameters. A block 124 will then report both the identityof the reamer and the particular reaming cup to the system. The block104 will use the identity of both the base or main tool and theparticular attachment to determine what is the appropriate consequentstep in the procedure.

FIG. 3 provides more detail on one method that the block 104 can use tomake the determination of the appropriate consequent step. A block 150identifies the current step in the procedure in much the same manner asthe block 100. Control then passes to a block 152 that determines if theinstrument or tool that is in the surgical field and has been identifiedby the block 102 is acceptable for the current procedure step. If thetool is acceptable, control passes to a block 154 that continues thecurrent step in the procedure and exits to the main routine. At the mainprogram, the system and method will again determine the current contextsimilar to the blocks 100 and 150. If the block 152 determines the toolis not acceptable for the current step, control will then pass to ablock 156 that determines if the tool is acceptable for a prior step inthe procedure. If the block 156 determines that the tool is acceptablefor a prior step, the control will pass to a block 158 that jumps to theprior step that has been determined by the block 156 and the routineexits to the main program. If the block 156 determines the tool is notacceptable for a prior step, then control passes to a block 160 thatqueries the future steps to determine if the current tool is acceptablefor a future step. If a future step is located that matches the tool,control will pass to a block 162 that jumps to the identified futurestep and the routine goes back to the main program. If there is nofuture step that is acceptable, control will pass to a block 164 thatdisplays a warning and a block 166 queries if the tool is changed. Ifthe identified tool has not been changed the method and system will loopback and the block 162 will continue to display the warning message. Ifthe tool is changed, the block 164 passes control to the block 152 thatstarts the process over. It is also possible for the user to overridethe choices made by the system and to exit the routine if no acceptabletool and step combination can be found or at any other time during theprocess.

As noted previously, the method and system can be used in conjunctionwith a surgical navigation system 200 as shown in FIG. 4. Any type ofsurgical navigation system can be used such as optical, both active(LEDs) and passive (reflectors), magnetic, inertial and combinationsystems. Other computer-assisted systems also can be used including RFIDbased systems, video imaging based systems, and the like. However, forease of description, the methods and systems of the present inventionwill de described using an optical active based system. The surgicalnavigation system 200 includes a computer 202 having internal CPU,memory and storage (not shown). The computer 202 can be any conventionalcomputer capable or running a suitable operating system. The computer202 will provide output and data to a display unit 204. The computer 202is also attached to a camera 206 that includes three separate CCD arrays208, 210 and 212. The three CCD arrays provide a three dimensional viewof the operating field of the surgical navigation system 200. The camera206 will also contain two transceivers 214 and 216. One or more trackingdevices 218 are placed in the view of the camera 206. Typically, onetracking device 218 is fixed in position to provide a reference framefor the camera 206 in the calculation of the Cartesian coordinates tolocate the various devices and the tracking devices 218. The trackingdevice 218 has a series of LEDs 220 and each tracking device 218 has atransceiver 222 to communicate with the surgical navigation system. Atypical surgical navigation system 200 is disclosed in U. S. publishedapplication 2001/0034530, the disclosure of which is hereby incorporatedby reference.

When a surgeon 224 introduces a surgical tool 226 having an attachment228, in the example as shown a drill bit, into the view of the surgicalnavigation system 200, the surgical navigation system will determine thecurrent state of the procedure as described above. Using the logic suchas that set out in FIG. 3, the system will jump to the appropriatedisplay screen and configure the surgical navigation system 200 toproperly display and guide the surgeon 224 to facilitate the surgeon's224 performance of the surgical procedure. The configuration may includelimiting the speed, size, temperature, pressure, or other parameter ofthe particular tool chosen by the surgeon 224. By moving between screenswithout the direct interaction from the surgeon 224 and by updating theinformation on those screens to reflect the choices made by the surgeon224, the embodiment of the system and method of the present inventionwill provide the surgeon 224 with the benefits of computer assistednavigation and workflow but allow the surgeon 224 to work directly on apatient 230 without having to directly interact or manipulate thesurgical navigation system 200.

FIG. 5 shows a further embodiment of the method and system of thepresent invention. In this embodiment, the system in a block 300determined the identity of the tool or instrument as has been describedpreviously. Then a block 302 will determine the location of the toolwithin the surgical field. Based on the location from the block 302 andthe identity of the tool 300 and the knowledge of the current state ofthe procedure, the system in a block 304 will determine the consequentstep and a block 306 will jump to or execute the proper consequent step.The block 306 will perform a similar procedure as shown in FIG. 3.

FIG. 6 shows a flow diagram of a system and method that allows thecontrol of auxiliary equipment, such as operating room lighting, videoand sound recording devices, suction devices, imaging devices, and thelike. A block 320 determines the current status of the system asdescribed above. Then a block 322 determines the identity of the tool orinstrument also as described above. Thereafter, a block 324 determinesthe identity and nature of the auxiliary equipment needed. A block 326then queries to see if the appropriate auxiliary equipment is availableand connected in some fashion or interface to the surgical navigationsystem 200. If the auxiliary equipment is not properly connected orconfigured, a block 328 displays a warning message and passes controlback to the block 324. If the block 326 determines that the appropriateequipment is in place and connected properly, a block 330 then activatesthe auxiliary equipment. An example would be if hospital policy hasdetermined that all surgical procedures be video recorded, during theearly set up portions of the procedure, the system will automaticallyswitch on the video camera (not shown) that may be mounted on a wall orother suitable support or surface. An additional example is a suctiondevice or tool that includes a suction feature and also is capable ofbeing tracked by the surgical navigation system 200. As the suctiondevice is brought into proximity to the patient 230, the block 324 willdetermine that the surgeon 224 needs suction. If the tool is not locatednear to the surgical incision, the block 326 will branch to the block328 that will display an indication that suction is not on. As the toolis place closer to the incision location, the block 328 will passcontrol to the block 330 that will activate the suction.

FIG. 7 is a flow diagram of an embodiment of the system and method ofthe present invention where the identification of two separate tools isdetected. A block 350 determines the current state of the system ormethod in the same manner as described above. A block 352 thendetermines the location and identity of a first tool that has beenintroduced into the surgical field or may currently be in the surgicalfield. The block 352 determines the identity and location as describedabove using conventional navigation techniques. In a similar manner, ablock 354 determines the location and identity of a second tool that hasbeen introduced into or are present within the surgical field. Controlthen passes to a block 356 that determines the appropriate consequentstep for the current tools and context. A block 358 then jumps to theconsequent step as determined by the block 356. While FIG. 7 uses twodifferent tools, there is no limit on the number of tools that can beidentified, subject only to the maximum number of different tools oritems the surgical navigation system 200 can simultaneously track.

FIG. 8 is a further embodiment of the method and system of the presentinvention. A block 380 identifies the particular tool or instrument in amanner similar to that described above. Control passes to a block 382that identifies the attachment or accessory that is being used with thetool. Based on the identification of the tool in the block 380 and theattachment in the block 382, a block 384 determines the appropriate toolparameter or parameters also using the context of the current step inthe procedure. A block 386 then will display proper tool and attachmentcombination on the display and a block 388 configures the surgicalnavigation system 200 to the particular parameters of the tool and theattachment combination.

As noted above, the system and method of the present invention have beendescribed primarily utilizing a surgical navigation system as anexample. The method and system of the present invention can also be usedfor a wide variety of applications where either robots or navigationsystems are used. Examples include manufacturing systems, complex partsassembly processes and systems, and the like.

Also, combinations of the various embodiments can also be incorporatedinto a system and method for application to various situations. Forinstance, the system and method may identify multiple tools and alsoswitch on a video recorder as the appropriate consequent action.

As shown in FIG. 9, the system and method may also incorporate an optionfor human override so that the user can direct the system and method tothe consequent step desired by the user. This feature is already afunction of current systems and can be incorporated into the reactiveworkflow system and method of the present invention as a fail-safeoption. In addition, the system and method may include an option toinclude a screen to confirm the chosen consequent step. Further, thesystem and method may also provide for a learning mode that would enablethe user to update the database with the particular preferences andrefinements to a procedure desired by a specific user.

A block 500 sets up the system based on information entered by a user,including but not limited to the identity of the patient, the type ofprocedure, the identity of the surgeon or surgeons, the date and otherinformation typically entered prior to the beginning of a surgicalprocedure. A block 502 then will load data from a database 504 based onthe specific entries provided in the block 500. The block 502 will thenconfigure the system to customize the system to the particularpreferences of the surgical team.

A block 506 will then determine the current context. At the beginning ofthe procedure, it will go to the first screen as determined by the setupin the block 500. As the procedure advances through he steps, the block506 will be the current context or step of the procedure. A block 508identifies the component or components that have been brought withinview of the system, for instance in a surgical procedure within thesurgical field. A block 510 then determines the consequent step based onthe current context and the components identified by the block 508. Theblock 510 may also use data from a database similar to the database 504.

If the user has chosen to put the system into a learning mode or has apreference to see confirmation screens, a block 512 will display aconfirmation message. If the consequent step is confirmed, the controlpasses to a block 514 that jumps to the consequent step and exits. Also,in learning mode, the system and method will update the database 504with the information relative to the consequent step. If the consequentstep is not confirmed, control passes to a block 516 that provides forthe user to indicate a consequent step. If the user does not chose tooverride the chosen consequent step, control will pass back to the block506 that again begins the process of determining the consequent step. Ifthe user indicates a consequent step at the block 516, control will passto a block 518 that jumps to the user defined consequent step. Inaddition, a block 520 queries if the database 504 should be updated, inwhich case the database 504 will be updated to indicate that the userchosen consequent step is a potential consequent step for the contextand components utilized. After the block 520, the system passes to ablock 522 that exits and returns to determining the consequent step forthe new context.

Numerous modifications to the present invention will be apparent tothose skilled in the art in view of the foregoing description.Accordingly, this description is to be construed as illustrative onlyand is presented for the purpose of enabling those skilled in the art tomake and use the invention and to teach the best mode of carrying outsame. The exclusive rights to all modifications that come within thescope of the appended claims are reserved.

1.-15. (canceled)
 16. A system to determine a consequent step within amulti-step procedure comprising: a first circuit that identifies acontext within the procedure; a second circuit that identifies acomponent usable in the procedure; and a third circuit that determinesthe consequent step within the procedure based on the identity of thecomponent and the context.
 17. The system of claim 16 wherein thecontext is a particular step within the procedure.
 18. The system ofclaim 16 that includes a fourth circuit to identify a particularlocation and wherein the third circuit determines the consequent stepbased on the location, the identity of the component, and the context.19. The system of claim 16 that includes a display unit that displays arepresentation related to the consequent step.
 20. The system of claim16 wherein the component is a multipart component capable ofself-identifying the component's composite parts.
 21. The system ofclaim 20 wherein the multipart component is a tool with an attacheddevice wherein the tool can identify the attached device.
 22. The systemof claim 20 wherein the multipart component is a tool with an attacheddevice wherein the attached device separately identifiable.
 23. Thesystem of claim 18 wherein the fourth circuit is incorporated within anavigation system.
 24. The system of claim 16 that includes a fifthcircuit to configure the consequent step with a parameter of thecomponent.
 25. The system of claim 16 wherein the consequent step is awarning that the component is inappropriate for the context.
 26. Thesystem of claim 16 wherein the consequent step includes controlling apiece of auxiliary apparatus.
 27. The system of claim 16 that includes asixth circuit to identify an additional component and wherein the thirdcircuit determines the consequent step based on the identity of thecomponent, the identity of the additional component, and the context.28. The system of claim 16 that includes a sixth circuit to move to thedetermined consequent step.
 29. The system of claim 16 wherein theprocedure is a surgical procedure.
 30. The system of claim 16 thatincludes a database of user preferences and wherein the third circuitdetermines the consequent step based on the database, the identity ofthe component, and the context.